RALEIGH, N.C. (WNCN) — For COVID-19 patients at this stage of the pandemic, there’s one subtle but important difference that should be clear: Being hospitalized with the virus is not the same thing as being hospitalized because of it.

But is the line between those two classifications being blurred? And is that leading to unreliable patient counts and death totals in North Carolina and beyond? A prominent medical expert thinks so.

THE CLAIM: Dr. Leana Wen, a former health commissioner in Baltimore and analyst who regularly appears on cable news stations, wrote an op-ed in the Washington Post titled “We are overcounting covid deaths and hospitalizations. That’s a problem.” In the piece, she argues that the hundreds of COVID deaths across the nation each day are overcounts, causing the risk of the disease to become overstated.

Conspiracy theorists have since latched onto her piece, which was rebutted by a Massachusetts doctor who’s an expert on those deaths.

THE FACTS: “I think counting is actually more complicated than many people realize,” said Dr. Pia MacDonald, an epidemiologist at RTI International.

Here’s how the North Carolina Department of Health and Human Services does it.

The 1,369 people designated as COVID-19 patients in the state’s hospitals as of Jan. 14 includes both types — those admitted for other conditions but tested positive for the virus, in addition to those who are hospitalized primarily because of COVID, NCDHHS spokeswoman Kelly Haight said.

“Typically, individuals that are admitted to the hospital are experiencing some sort of symptom severe enough to warrant hospital admission, whether that be heart trouble, severe dehydration, a severe injury, etc,” Haight said in a statement. “If these same individuals test positive for COVID-19, they have to be placed in COVID-cohorted space which requires more use of PPE, staff, space etc. same as a person that is admitted specifically for COVID-19 related complications.”

But for the death total, it’s different. 

The NCDHHS dashboard says that as of Jan. 1, 2022, a death is only counted as one if the person was reported as a COVID case and had the virus listed as the primary or underlying cause of death. That accounts for just 8,101 of the 27,963 total deaths for whom the specific date of death is known.

Before then, the state considered it a COVID death if a person tested positive for the virus, did not fully recover and had no alternative cause of death identified. That adds up to the first 19,862 deaths of the pandemic — or 71 percent of the total since March 2020.

But are we overcounting?

“Maybe there’s some overcounting, but I do think there’s a lot of undercounting as well,” said Dr. David Wohl, an infectious disease expert at the University of North Carolina School of Medicine.

It’s a change: During the initial omicron surge a year ago, patients who would check into hospitals for broken bones and other ailments frequently would wind up testing positive for COVID.

“Nowadays, it’s flipped,” Wohl said. “And there are more and more people now getting admitted to the hospital with COVID-19, due to COVID-19, for COVID-19, than just happened to have it in their nose at the time they came in for another reason.”

But here’s a counterintuitive question: Do those raw patient counts even matter? 

MacDonald says that as long as the way they are counted remains consistent over time, the cumulative total has less significance than how they are changing — for example, is the total going up or down quickly or slowly?

“It’s also a good indicator for epidemiologists to look at and see if the people who are getting hospitalized is changing over time,” she said.

Public health officials in Massachusetts have broken out their hospital numbers, separating those hospitalized primarily for COVID from those who were admitted for an unrelated issue before they were screened and also found to have the virus.

Haight says her agency can not provide a similar breakdown in North Carolina. Wohl says it is tracked by UNC’s hospitals.

“In most cases, it just has to do with the way that diagnoses are being made when people enter the hospital,” Wohl said.

CBS 17’s Joedy McCreary has been tracking COVID-19 figures since March 2020, compiling data from federal, state, and local sources to deliver a clear snapshot of what the coronavirus situation looks like now and what it could look like in the future.